| Payment ID | 7077 |
|---|---|
| Date Created | 08/29/22 3:02 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1780 |
| Authorization Number | |
| Applicant Information | |
| Name | Rebecca Mcbride |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170800195 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $984.80 |
| Receipt Date | 08/03/2022 |
| Comments | Studio 6 departure date is 8/20/2022 |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/29/2022 |
